STARS Patient Information
What is a psychogenic blackout?
Psychogenic blackout is a medical term for a blackout that can look like reflex syncope or an epileptic seizure but is not related to either. During a psychogenic blackout, people lose some control of their body.
Attacks might involve:
- Passing out and falling to the floor
- Jerking movements of your arms or legs
- Losing control of your bladder or bowel
- Going blank or absent
- Feeling out of touch with your surroundings
- Inability to remember the attack
Some of these symptoms can lead people to confuse these attacks with other causes of blackouts such as reflex syncope or epilepsy.
How is a blackout diagnosed?
A psychogenic blackout can be difficult to diagnose. Most often it occurs in young adults as a result of stress or anxiety. However, the link between blackouts and stress may not be obvious.
‘Psychogenic’ does not mean that people are ‘putting it on’. In most cases a psychogenic blackout is an involuntary reaction of the brain to pressure or distress. Psychogenic blackouts sometimes develop after people have experienced ill treatment or trauma. They are sometimes a reaction to a horrific experience in the past which a patient has not able to come to terms with.
Specialists in treating blackouts (such as electrophysiologists and neurologists) can sometimes make a clear diagnosis when you, or someone who has seen an attack, describes it in detail. Although a psychogenic blackout does resemble an epileptic seizure or reflex syncope, there are small but important differences between these types of attacks:
- Psychogenic attacks tend to be numerous, often occurring several times a day, or at the same time each day. This differs from reflex syncope (vasovagal syncope, neurocardiogenic syncope) which is typically no more frequent than four or five times a year.
- During an episode, the eyes may be tightly closed with a lid flutter, whilst during reflex syncope or epilepsy the eyes are often open.
- Patients can experience psychogenic syncope when they are lying on their back.
- Typical symptoms associated with reflex syncope, such as looking pale or becoming sweaty, maybe absent.
- A psychogenic blackout often lasts much longer than reflex syncope.
What causes psychogenic blackouts?
The medical profession is gradually beginning to recognise and understand what causes blackouts. It is accepted it is not caused by physical problems and it happens for different reasons in different people.
It is likely a psychogenic blackout can happen when there is a temporary problem with the way the brain is working. The brain may become “overloaded” and “shut down” for a short while when faced with some kind of threatening feeling, situation, thought or memory. Although it is thought stress plays an important part in these attacks, people can pass out at times when they do not feel particularly stressed.
Sometimes the first attacks are related to an upsetting or frightening experience, or some other great loss or change. These experiences may be recent or in the past. Sometimes it is not clear why attacks have started, or they seem to have started just as some life stress was getting better. Stress can also make it difficult for a person to get over their attacks once they have started. Examples of this include relationship problems, ill health, bereavement and money worries or even just the stress of living with psychogenic blackouts. In recent years it has become clear psychogenic blackouts are not uncommon amongst students struggling with the stresses of examinations and school life, peer pressure and the worries of getting their first job. These sorts of blackouts often become much less of a problem after college or university life.
How can stress be the cause?
It is very common for people to think there must be a physical cause for psychogenic blackouts. They are physical symptoms after all. However, there are many examples of how emotional stress can cause physical reactions in the body. These include blushing when you are embarrassed, feeling “butterflies” in your stomach when you are nervous, and getting a headache when you have been worrying or have had a bad day. Another familiar idea is someone fainting when they are shocked.
When emotional stress is particularly severe or has been going on for a long time, more serious physical problems can arise. In some cases this leads to disability. There are many conditions where stress is thought to play a part, including chronic fatigue, postural tachycardia syndrome, non-cardiac chest pain, fibromyalgia and irritable bowel syndrome. It may be that not all psychogenic blackouts/ non-epileptic attacks are caused by stress but further research is needed to answer this.